Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia.
BMJ Open. 2022 Jul 12;12(7):e062409. doi: 10.1136/bmjopen-2022-062409.
Investigate the impact of the COVID-19 pandemic on perinatal outcomes in an Australian high migrant and low COVID-19 prevalent population to identify if COVID-19 driven health service changes and societal influences impact obstetric and perinatal outcomes.
Retrospective cohort study with pre COVID-19 period 1 January 2018-31 January 2020, and first year of global COVID-19 period 1 February 2020-31 January 2021. Multivariate logistic regression analysis was conducted adjusting for confounders including age, area-level socioeconomic status, gestation, parity, ethnicity and body mass index.
Obstetric population attending three public hospitals including a major tertiary referral centre in Western Sydney, Australia.
Women who delivered with singleton pregnancies over 20 weeks gestation. Ethnically diverse women, 66% overseas born. There were 34 103 births in the district that met inclusion criteria: before COVID-19 n=23 722, during COVID-19 n=10 381.
Induction of labour, caesarean section delivery, iatrogenic and spontaneous preterm birth, small for gestational age (SGA), composite neonatal adverse outcome and full breastfeeding at hospital discharge.
During the first year of COVID-19, there was no change for induction of labour (adjusted OR, aOR 0.97; 95% CI 0.92 to 1.02, p=0.26) and a 25% increase in caesarean section births (aOR 1.25; 95% CI 1.19 to 1.32, p<0.001). During the COVID-19 period, we found no change in iatrogenic preterm births (aOR 0.94; 95% CI 0.80 to 1.09) but a 15% reduction in spontaneous preterm birth (aOR 0.85; 95% CI 0.75 to 0.97, p=0.02) and a 10% reduction in SGA infants at birth (aOR 0.90; 95% CI 0.82 to 0.99, p=0.02). Composite adverse neonatal outcomes were marginally higher (aOR 1.08; 95% CI 1.00 to 1.15, p=0.04) and full breastfeeding rates at hospital discharge reduced by 15% (aOR 0.85; 95% CI 0.80 to 0.90, p<0.001).
Despite a low prevalence of COVID-19, both positive and adverse obstetric outcomes were observed that may be related to changes in service delivery and interaction with healthcare providers. Further research is suggested to understand the drivers for these changes.
调查 COVID-19 大流行对澳大利亚高移民和低 COVID-19 流行地区围产期结局的影响，以确定 COVID-19 驱动的卫生服务变化和社会影响是否会影响产科和围产期结局。
回顾性队列研究，包括 COVID-19 前时期（2018 年 1 月 1 日至 2020 年 1 月 31 日）和全球 COVID-19 第一年（2020 年 2 月 1 日至 2021 年 1 月 31 日）。进行了多变量逻辑回归分析，调整了混杂因素，包括年龄、地区社会经济地位、胎龄、产次、种族和体重指数。
在澳大利亚西悉尼的三家公立医院就诊的产科人群，包括一家主要的三级转诊中心。
分娩单胎妊娠 20 周以上的妇女。具有种族多样性的妇女，其中 66%为海外出生。该地区有 34103 名符合纳入标准的产妇：COVID-19 前 n=23722，COVID-19 期间 n=10381。
引产、剖宫产分娩、医源性和自发性早产、小于胎龄儿（SGA）、复合新生儿不良结局和全母乳喂养出院。
在 COVID-19 第一年，引产没有变化（调整后的 OR，aOR 0.97；95%CI 0.92 至 1.02，p=0.26），剖宫产分娩增加了 25%（aOR 1.25；95%CI 1.19 至 1.32，p<0.001）。在 COVID-19 期间，我们发现医源性早产没有变化（aOR 0.94；95%CI 0.80 至 1.09），但自发性早产减少了 15%（aOR 0.85；95%CI 0.75 至 0.97，p=0.02），SGA 婴儿出生时减少了 10%（aOR 0.90；95%CI 0.82 至 0.99，p=0.02）。复合不良新生儿结局略高（aOR 1.08；95%CI 1.00 至 1.15，p=0.04），全母乳喂养出院率下降 15%（aOR 0.85；95%CI 0.80 至 0.90，p<0.001）。
尽管 COVID-19 发病率较低，但仍观察到阳性和不良产科结局，这可能与服务提供的变化和与医疗保健提供者的相互作用有关。建议进一步研究以了解这些变化的驱动因素。
